Zoe: Therapy-led practices are quite uncommon still, although, how they can work, and their benefits have been hot topics of conversation for the past three or four years now. My sense is the idea is not as popular as we would have hoped by now, but can you outline some of the benefits to people that it can offer?
Cat: I agree that it has been a hot topic of conversation for a number of years now, but I think sadly, a lot of legislation has had to change in order to catch up with that conversation, and we're still not where we need to be yet.
We’ve had direct access for about 11 years now, but the exemption legislation has only just been passed, and we are only just now seeing exemptions training courses become available. So, we can work on the NHS; we can do direct access exams, but many still can't use local anesthetic within the exemptions framework. So there are barriers and blockers to direct access being fully implemented.
When you're looking at private practices, a therapy-led model works extremely well and there are quite a few examples of this. There's an amazing practice in Preston that's a five-surgery therapy-led practice that started as a squat and is absolutely thriving.
There are also a number of practices that we've flipped from a dentist top-down model to a therapy- led model. The benefit of that is that you are allowing your dentist to reach their earning potential. You are making the most of the surgery time you have with your patients and, when your dentists are in, they're able to focus on the treatments that are the genuine earning treatments, rather than the loss-leading ones.
But more than that, it reduces some of the pressure on business owners regarding the income of the surgery and of the business. Because typically what you tend to find is the business owner, if they're a dentist owner, is usually the highest earner in the practice as well when it comes to their clinical work. That can mean that selling the practice can become very difficult for them. It puts them under an awful lot of pressure to keep the income ticking over, and so there’s no headspace for them to run that business. I feel a lot of government legislation treats business owners as though all they do is run a business, but in dentistry that's very rarely the case.
A therapy-led model takes all of the small things, such as the checkups, the communication, everything that is day-to-day typical income, and puts it into the therapist's diary. That means the larger pieces of treatment can be distributed amongst the associates who are good at those treatments. Essentially, it makes sure that the associates’ diaries can be filled with already qualified patients. So, these patients are not shopping around; they've already agreed to the treatment and had all the indices, the photos, scans, and X-rays that they might need, and they're landing in the dentist's lap, ready for treatment. This means you're maximising the income of that surgery. It also means that the high earners are no longer the practice owner.
It also means that the patient is being looked after by an entire team. They won't only have their one dentist that they go to see every six months. And so, should that one dentist decide to up and leave, the practice doesn't lose a whole cohort of patients as well down the road to the squat that they've set up. Which, in this digital age, is a genuine concern.
So, I truly feel that having a dental therapy-led model, or at least more of a therapy-based team approach, allows business owners to step away, take a bit of a break, possibly reduce their hours, or focus on the treatments that they really enjoy doing. It also encourages the team to do the same thing and encourages the patient to become loyal to the practice rather than just one person.
Zoe: It feels like a safer model, as you're not creating that single point of dependency. Why do you think right now it's not taking off as we thought it would? Is it the wait for changes to regulation that would allow therapists to do more without having to rely on the dentist? Or do you think it's just nervousness around how it would work for them?
Cat: It's clearly a confidence issue, and this is why I set up the Modern Therapist because we have a confidence issue both from the therapist side and from the practice owner and dental associate side. There's a lack of confidence in doing therapy, but there's also a lack of confidence in what is dental therapy.
There are so many dentists I have spoken to, and I'm talking in the hundreds here, who still don't really know what the scope is. Even though a lot of universities now train their dental therapists alongside their dentists, which certainly didn't happen for me when I trained. I didn't meet a dentist in my entire three-year degree, but nowadays that happens more frequently. But there's still a lack of understanding, of communication, and of awareness. As well as this, we also have the problem of 70% of dental therapists who have not been doing dental therapy. We need to collaborate in order to grow that model.
However, there's no point in jumping in with both feet, and this is where I come in with consulting. I tend to go into practices and say, ‘Right, hold up. I know you want to run a dental therapist-led model, but how is that actually going to look? What does your therapist feel confident doing? What does your dentist feel confident receiving from the dental therapist? And does the dental therapist know what treatments each dentist likes to do?’
So, we need to have a huge conversation around all that. It's not a quick and easy transition. It is something that must be phased, it needs to be considered, and it has to be documented. In private practice, even without exemption legislation, we are fine because we have PGDs (patient group directives) that cover our fluoride applications and our local anaesthetics. And there are a lot of successful, therapist-led, no dentist practices operating at the moment.
But, as you say, it's not taken off as quickly as it could have done. I think this is because there's an awful lot of misunderstanding, lack of education, and we need to work more collaboratively.
Zoe: Thanks, Cat. Let’s hope your example paves the way for others.
For a longer version of this conversation, watch the webinar in full.
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About Zoe
Zoe is the Head of Sales at Practice Plan and has over 30 years’ experience in the dental sector including working as a group business manager for a corporate group, a dental nurse, a head receptionist, and a practice manager.
Zoe is passionate about supporting practices and can offer invaluable advice on how to strategically and successfully run your business.
About Cat
Multi award winning Dental Therapist, Cat Edney, has over fifteen years’ experience working in specialist and private practice in the UK. In this time, she has developed a passion for multidisciplinary team working in the dental setting – with a focus on maximising the use of the full dental team to ensure profitability alongside patient care and engagement.
Cat lectures internationally as a clinical educator and speaker and has developed hands on dental courses under her training brand ‘The Modern Therapist’ which aims to educate the dental profession about the role and integration of Dental Therapy, alongside focusing on providing gold standard hands on training and ongoing support to dental teams.
